Before/After School Program Enrollment Form

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Before/After School Program Enrollment Form

Purpose of the Before/After School Program Enrollment Form

This form is used to enroll a child in the school’s before and/or after-school program. It collects important information about the child and their participation schedule, as well as emergency contacts and any special needs. Parents or guardians must review and complete this form to ensure their child’s safe and successful participation in the program.

Program Enrollment Details.

Please indicate which program you are enrolling your child in:

Before School Program

After School Program

Both Before and After School Programs

Please select the days your child will attend:

Monday

Tuesday

Wednesday

Thursday

Friday

Please indicate the anticipated drop-off and pick-up times. *

Please list all allergies or medical conditions. *

Please fill out student information below.

Student First Name: *

Student Last Name: *

Grade:

List all individuals authorized to pick up your child from the program(s).

Full Name: *

Phone Number: *

Relationship to Student: *

Full Name:

Phone Number:

Relationship to Student:

Full Name:

Phone Number:

Relationship to Student:

Please provide at least one emergency contact who can be reached if you are unavailable.

Emergency Contact Full Name #1: *

Emergency Contact Phone Number #1: *

Emergency Contact Email #1: *

Emergency Contact Full Name #2:

Emergency Contact Phone Number #2:

Emergency Contact Email #2:

By signing below, I verify that I am the parent or legal guardian of the child named above and that I have read, understood, and agree to the terms of this Before/After School Program Enrollment Form.

Use the space above to sign your name